April 2021 COPMM newsletter
Insights into Youth Suicide: Tasmanian Update
Youth suicide sadly continues to be an issue in Tasmania. COPMM ‘s annual recommendations have referenced youth suicide every year since 2008. COPMM therefore welcomes the review of CAMHS services (completed by Prof Brett McDermott in 2020) and the Government response to the review.
COPMM acknowledges that there are a range of both recognised risk and preventative factors for youth suicide, and that excellent mental health services will not prevent all suicides, nor address all risks such as socioeconomic disadvantage, trauma or substance misuse. Improvement in availability of services and expert clinicians however may play an important role in decreasing the number of Tasmania’s youth lost to suicide.
The review made seven recommendations, including establishing a statewide service, aligning the model of service with the Australian National Mental Health Strategy, and improving service delivery and efficiency through service reform, adequate staffing, funding, accommodation and research and training.
The Government accepted all seven recommendations of the review. A timeline for implementation and funding have not yet been announced.
Of particular relevance to this committee are the recommendations for addressing known service gaps. Many of the young Tasmanians who have committed suicide in the past may have had some of their needs met, and possibly had their trajectories altered by the proposed services, especially services working in an early intervention mode.
COPMM therefore commends the government on accepting these recommendations and strongly urges the government to proceed to establish and resource these services statewide. Services particularly relevant to prevention of youth suicide include the following:
- Children in Out of Home Care Intensive Support Team: A highly specialised intensive mental health intervention and consultation service for those children/young people who have complex mental health care needs.
- Youth Forensic Mental Health Service: Multidisciplinary team, including adolescent psychiatrists, that provides specialist assessment, offence-specific interventions, risk assessment, and management plans.
- Youth Early Intervention Service: Focuses on early recognition and treatment for young people experiencing early psychosis and other emerging severe and complex non-psychotic disorders. Key elements include flexible access for assessment and treatment, assertive outreach, and a range of interventions tailored to individual need.
- Perinatal and Early Years Mental Health Service: An expansion of the current Perinatal and Infant Mental Health
Service (PIMHS), to provide greater state-wide coverage and consistency. The expansion will also allow PIMHS to provide a greater range of treatment options.
Mandatory Improvement to Button Battery Safety to Save Lives
As outlined in the Media Release and announcement made on 21 December 2020, the Morrison Government is delivering on its commitment to improve the safety of button batteries with the introduction of new mandatory safety and information standards to help protect Australian children.
In Australia three children have died from injuries sustained as a result of swallowing a button battery, and since December 2017, there have been at least 44 individual cases where young children have suffered severe injuries following the ingestion or insertion of button batteries. This equates to one child sustaining a serious button battery injury every month, with some of them sustaining lifelong injuries. As button batteries are used in a wide range and variety of products found in people’s homes a comprehensive and broad solution is required. Therefore, the new mandatory safety and information standards will require:
- secure battery compartments for consumer goods that contain button batteries, where the batteries are intended to be replaced, to prevent children from gaining access to the batteries;
- compliance testing of consumer goods that contain button batteries, whether or not the batteries are intended to be replaced, to demonstrate the battery is secure and cannot be easily released;
- child resistant packaging for button batteries, based on their risk profile, to prevent children from gaining access to the batteries; and
- warnings and information to alert consumers that a button battery is included with the product.
No other country in the world has been able to design and deliver risk based mandatory regulation that applies to all consumer products containing button batteries. The work of the ACCC who have shared the Morrison Government’s concern about the safety surrounding the use of button batteries has been commended. The ACCC has undertaken extensive consultation in developing these new standards including with industry, health professionals, consumer advocates, retailers, suppliers and government. It is important to note that the majority of stakeholders who made submissions supported new mandatory safety and information standards.
A transition period of 18 months has been provided to allow industry to implement any manufacturing and design changes to products and packaging and undertake any testing necessary to ensure compliance with the new mandatory safety and information standards.
Further information about the new standards is available on the Product Safety Australia website
COVID-19, Pregnancy and Preterm Birth Rates in Tasmania
The global COVID-19 pandemic has posed yet another potential threat to pregnant women and their babies. As a result of the pandemic, changes to the delivery of maternity care occurred both internationally, and here in Tasmania, including adoption of tele-health consultations, reduction in frequency and duration of face-to-face consultations, and temporary visitor restrictions. While these changes have largely returned to ‘normal’, 2020 was a difficult time to have a baby. Now, as COVID-19 vaccination rolls out across Tasmania, given the low level of community transmission in Australia, the current recommendation is to avoid routine vaccination in pregnancy, and further information can be found on the RANZCOG website.
While the majority of women who are infected during pregnancy will have mild disease (similar to the non- pregnant population), it appears that pregnant women with COVID-19 are more likely to need admission to an intensive care unit and require mechanical ventilation. International studies have also reported significant changes in perinatal outcomes such as stillbirth and preterm birth. The spontaneous preterm birth rate in COVID-19 infection is around 6%, but the rate of iatrogenic preterm birth is increased three-fold due to the need for delivery to assist with mechanical ventilation in the severely ill.
In mid-2020, international media alerted us to a decrease in the preterm birth rate in some countries following various periods of lockdown. A Danish study reported a 91% reduction in extremely preterm birth < 28 weeks during a 4-week lockdown period (March 12 – April 14 2020) compared with the previous 5 years, but with no change in preterm birth noted > 28 weeks.1 Similarly, a study from one health region of Ireland reported a 73% reduction in very low birth weight infants, and a 100% reduction in extremely low birth weight infants in their period of lockdown (January to April 2020), compared with the preceding 20 years.2
The mechanism behind this is unclear, and many hypotheses have been suggested. As up to 70% of extremely preterm birth (< 28 weeks) has some inflammatory/infectious origin, perhaps the decrease in preterm birth rates in these studies is due to increased hand washing and/or the avoidance of other bacterial or viral infections. A reduction in environmental pollution, reduction in activity, or stress from travel and the workplace may have also played a role, or, the result could purely be by chance.
The Australian Preterm Birth Prevention Alliance is attempting to address this question. A current project, led by Professor Jonathan Morris (UNSW), is examining the pregnancy and birth statistics from each of the eight states and territories over the past 12 months. Throughout Australia, different states have had different periods of lockdown/restrictions, and also vastly differing numbers of COVID-19 infection. There have also been other significant environmental influences (such as bushfires and drought) that may have had an impact on preterm birth rates during this same period.
Melbourne endured some of the strictest pandemic restrictions in the world, with data from over 97,000 births and the effect of Melbourne’s first lockdown presented by A/Prof Lisa Hui at RANZCOG’s Virtual Annual Scientific Meeting (VASM) last month. This data from the Collaborative Maternity and Newborn Dashboard for the COVID- 19 pandemic (CoMaND), suggested that for the first period of 2020 (until July 31) there was no significant increase in stillbirth, and in contrast to international reports, a decrease in extremely preterm birth was not seen.
There was no significant increase in fetal growth restriction (< 3rd centile), NICU/SCN admissions, or delivery for preeclampsia (despite a small and non-sustained increased in induction of labour and necessary changes to the delivery of maternity care), but a significant increase in fetal macrosomia and maternal overweight and obesity was seen toward the end of the reporting period. This data raises further interesting questions about the ongoing effect of lockdown (and the COVID-19 pandemic) on maternity outcomes, and analysis of the second six-month period of 2020 is eagerly awaited.
In Tasmania, promising early analysis suggests our preterm birth rate is on the decline, with formal publication expected soon. This may be due to social distancing and the measures described above, but it appears the preterm birth rate was on the decline well before the COVID-19 pandemic. Ongoing efforts to introduce and sustain elements of the Preterm Birth Prevention Initiative continue across the State. Recently, Dr Rachel Stafford conducted an audit of the uptake of cervical length measurement at the morphology scan and presented her results as an E-poster at the RANZCOG VASM. Dr Stafford compared a cohort of the first 200 primiparous women who delivered at the Royal Hobart Hospital over a six-month period in 2017 and a second similar cohort in 2019, before, and after introduction of the preterm birth prevention initiative. Cervical length was measured 27% of the time in 2017, compared to 95% in the 2019 cohort (p < 0.0005). It is encouraging to find that our cervical length screening rate has significantly improved since the introduction of the Initiative in Tasmania. With ongoing effort, and timely management of those identified at increased risk of preterm birth, it is hoped to have continued support for further improvements in the health of the women and babies of Tasmania.
- Hedermann G, et al. Arch Dis Child Fetal Neonatal Ed. 2021 Jan; 106(1): 93-95. doi: 10.1136/archdischild-2020-319990. Epub 2020 Aug 11.
- Philip RK, et al. BMJ Global Health, 2020;5:e003075. doi:10.1136/ bmjgh-2020-003075.
Sleep Related Infant Deaths and Socio-Economic Disadvantage
The South Australian Child death and Serious Injury Review Committee has recently released research findings that have shown that almost half of all sleep-related infant deaths occur in the State’s most socio-economically disadvantaged areas. Infants in these areas are four times as likely to die suddenly and unexpectedly than infants who live in the least disadvantaged areas. The decline in infant deaths over the years has shown that prevention messaging and education work, however there is an ongoing need for targeted efforts to stop preventable sleep-
related deaths, especially in South Australia’s most disadvantaged areas. Further details are provided via the Child Death and Serious Injury Review Committee website
Committees of COPMM
Paediatric Mortality & Morbidity
This Committee is chaired by Dr Michelle Williams and meetings continue to be held remotely to progress the review and classification of reported statewide paediatric death cases. This year the Australian and New Zealand Child Death & Prevention Group (ANZCDRPG) will meet virtually on May 18th and May 20th 2021.
Perinatal Mortality & Morbidity
The Committee chaired by Professor Dargaville continues to recommend that Tasmania’s private hospitals use PSANZ guidelines to report on perinatal cases to provide COPMM with more comprehensive information on reported stillbirth cases as required. The updated Tasmanian Perinatal Data Collection Form can be accessed via the COPMM’s website. Clinicians are requested to use the Third Edition Version 3.1 for classification of all perinatal deaths from 2019 onwards.
Maternal Mortality & Morbidity
This Committee that is chaired by Associate Professor Amanda Dennis will finalise its review and classification of maternal death cases reported in Tasmania in 2019 prior to drafting its report. Progress of the Australian Maternity Outcomes Surveillance System (AMOSS Project) will continue to be tracked and its relevance to Tasmania’s reporting assessed etc.
The Data Management Committee’s Working Group have met to discuss preparations on its latest COPMM Annual Report based on available audited 2019 data. This report will be tabled in Parliament together with COPMM’s Operations Report as part of the Department of Health’s Annual 2020-21 in October 2021 (dates tbc). The Committee continues to monitor national developments in the Congenital Abnormality Registers as well as a national push to improve data timeliness and in-principle support for earlier supply of mortality data to AIHW.
Council’s Operations Report and latest Annual Report were both tabled in Parliament on 15th November 2020. It is expected that the Progress Against Actions report in response to this Report will be progressed in 2021 subject to the continued impact of COVID-19 situation. Upon finalisation, it will be submitted to the Health Minister for consideration in due course.
Membership for the current term (May 2019- May 2022) in accordance with the Terms of Reference includes:
- Dr Michelle Williams (Chair- Paediatrician & RACP rep)
- Professor Peter Dargaville (employed in the delivery of Neonatal Services)
- Dr Anagha Jayakar (UTAS rep)
- Associate Professor Amanda Dennis (UTAS Rep)
- Dr Jill Camier (RACGP rep)
- Ms Kate Cuthbertson, Barrister at Law (Council nomination)
- Ms Sue McBeath (ACMTas rep)
- Dr Tania Hingston (RANZCOG rep)
- Dr Scott McKeown (Department of Health Representative) and
- Commissioner for Children and Young People, Ms Leanne McLean.
The Council website continues to archive newsletters, Annual Reports and other relevant resource information.
Enquiries: To Manager, Dr Jo Jordan; email: [email protected]